Psychopharmacological Enhancement

The Socio-Political Roles of Neuroethics and the Case of Klotho

An increasing amount of very diverse scholarship self-identifies as belonging to the field of neuroethics, illuminating a need to provide some reference points for what that field actually entails. We argue that neuroethics is a single field with distinct perspectives, roles, and subspecialties. We propose that-in addition to the three traditional perspectives delineated by Eric Racine-a fourth, socio-political perspective, must be recognized in neuroethics. The socio-political perspective in neuroethics focuses on the interplay between the behavioral as well as the brain sciences and the socio-political system; this interplay includes social regulation in addition to all other realistic elements of social and political neurodiscourses. Thus, defining what-if any-roles the socio-political perspective in neuroethics might have is a pressing issue. Doing so could provide guidance for defining the criteria for prospective ethical evaluations in neuroethics. A promising approach to doing this could be by describing the roles of neuroethics in terms of the more concrete examples of the roles of political philosophy in general, as in the tradition of John Rawls. We take klotho, the supposed "longevity protein," as a modern neuroethics case to exemplify the obstacles faced in securing neuroethics' legitimacy and how the Rawlsian framework we propose may be applied to handle cases such as this. Ultimately, the socio-political perspective in neuroethics should not be swayed by the media hype and ought to offer useful ethical guidance and articulation of genuine ethical concerns to policy makers and the public alike.

Nonconsensual neurocorrectives, bypassing, and free action

As neuroscience progresses, we will not only gain a better understanding of how our brains work, but also a better understanding of how to modify them, and as a result, our mental states. An important question we are faced with is whether the state could be justified in implementing such methods on criminal offenders, without their consent, for the purposes of rehabilitation and reduction of recidivism; a practice that is already legal in some jurisdictions. By focusing on a prominent type of view of free action, which I call bypassing views, this paper evaluates how such interventions may negatively impact the freedom of their subjects. The paper concludes that there will be a tension between the goals of rehabilitation and reduction of recidivism, on the one hand, and the negative impact such interventions may have on free action, on the other. Other things equal, the better that a particular intervention is at achieving the former, the more likely it is to result in the latter.

Social Justice Theories as the Basis for Public Policy on Psychopharmacological Cognitive Enhancement

Psychopharmacological cognitive enhancements could lead to a higher quality of life of healthy individuals with lower cognitive capacities, but the current regulatory framework does not seem to enable access to this group. This article discusses why Sen’s Capability Approach could open up such access, while two other modern social justice theories – utilitarianism and Rawls’ Justice as Fairness – could not. In short, the utilitarian approach is proven to be inadequate, due to practical reasons and having a low chance of real-world success. Rawls’ Justice as Fairness seems to be problematic because of conflicting stances that follow from his First Principle of Justice. The Capability Approach has the greatest chance of success in the context of these substances, because of arguments that can be identified under the banners of agency/self-respect and the way the public views those who take the capability path out of their poor situation. The article also discusses general and practical problems with psychopharmacological cognitive enhancement that should be addressed when writing new policy on this topic.

Distributive justice, equality and the enhancement of human cognition: A commentary on fairness and 'cognitive doping'

What implications might the use of techniques to enhance human cognition have for the kind of polities or civil societies we inhabit? What might political philosophy, if anything, have to tell us about the desirability of using drugs to increase our intellectual powers? Much of the focus in contemporary debates about human enhancement has been upon the ethical desirability of endeavouring to enhance our capacities: should we be meddling with 'human nature', as it were? Therapeutic uses of drugs are regarded as acceptable but enhancement is frowned upon in much of this literature. This rejection of enhancement is especially prevalent in the area of sport where there is a great deal of opposition to doping. Herein I take a somewhat different approach and explore enhancement as a problem in political philosophy and, more specifically, as a problem of distributive justice. Should the enhancement of human intellectual functioning be rejected on distributive grounds of equality? Alternatively, might it be plausibly be argued that distributive justice requires such enhancement? In this paper I shall outline two contemporary theories of justice-namely, the Egalitarianism and the Rawlsian Prioritarianism-and then consider what these principles might tell us about the political legitimacy (or otherwise) of 'doping for intellect'.

Memory, Neuroscience and Memory Enhancement

This paper advances a new and updated understanding of memory that should also change the coordinates of the memory enhancement debate. Instead of thinking of memory as a storehouse, we should think of memory from a narrative perspective. This view allows for a better understanding of the process in which we actually construct our memories by elaborating meaningful summaries, rather than adding discrete elements. I argue that this new way of thinking about memory makes most of the memory enhancement technologies we have or will have in the near future much less ethically problematic. The main idea is that (biological) memory interacts with memory enhancement in the creative and re-elaborative way it ordinarily does. To conclude, I discuss some cases to illustrate the previous points.

How perceived substance characteristics affect ethical judgement towards cognitive enhancement

Some individuals seek to enhance their cognitive capabilities through the use of pharmacology. Such behavior entails potential health risks and raises ethical concerns. The aim of this study was to examine whether a precursor of behavior, ethical judgement towards the use of existing biological cognitive enhancers (e.g., coffee, legal and illegal drugs), is shaped by the perceived characteristics of these cognitive enhancers. Students and employees completed an online questionnaire which measured perceived characteristics of 15 substances presented as potential cognitive enhancers and a measure of ethical judgement towards these cognitive enhancers. Results of mixed model regression analyzes show that ethical judgement is more favourable when cognitive enhancers are perceived as being legal, familiar, efficient, and safe for users' health, supporting all hypotheses. Results further show that 36% of variance (in the null model) lies at the level of cognitive enhancers and 21% at the level of participants. In conclusion, cognitive enhancers vary widely in terms of ethical judgement, which is explained by the perception of the mentioned characteristics. Implications regarding prevention and policy-making are discussed.

Associations Between the Big Five Personality Traits and the Non-Medical Use of Prescription Drugs for Cognitive Enhancement

While the number of studies of the non-medical use of prescription drugs to augment cognitive functions is growing steadily, psychological factors that can potentially help explain variance in such pharmaceutical cognitive enhancement (CE) behavior are often neglected in research. This study investigates the association between the Big Five personality traits and a retrospective (prior CE-drug use) as well as a prospective (willingness to use CE drugs) measure of taking prescription drugs with the purpose of augmenting one's cognitive functions (e.g., concentration, memory, or vigilance) without medical necessity. We use data from a large representative survey of German employees (N = 6454, response rate = 29.8%). The Five Factor Model (FFM) of Personality was measured with a short version of the Big Five Personality Traits Inventory (BFI-S), which includes: openness to experience, conscientiousness, extraversion, agreeableness, and neuroticism. Together with this, demographic variables such as gender, age, education, and income were used as potential confounders in multiple logistic regression models. Our results show a 2.96% lifetime prevalence of CE-drug use and a 10.45% willingness to (re)use such drugs in the future. We found that less conscientious and more neurotic respondents have a higher probability of prior CE-drug use and a greater willingness to use CE drugs in the future. No significant effects were found for openness, extraversion, or agreeableness. Prior CE-drug use was strongly associated with a greater willingness to take such drugs in the future. This study shows that specific personality traits are not only associated with prior enhancement behavior, but also affect the willingness to (re)use such drugs. It helps increase understanding of the risk factors of CE-drug use, which is a health-related behavior that can entail severe side-effects for consumers. The knowledge gathered can thus help improve interventions aimed at minimizing health problems.

The Complexity of Neuroenhancement and the Adoption of a Social Cognitive Perspective

This contribution attempts to provide a broad perspective to the psychological study of neuroenhancement (NE). It departs from the assumption that, as the use of performance enhancing substances in sport, the use of substances with the aim of improving one's cognitive, motivational and affective functioning in academic domains is a goal-directed behavior. As such, its scientific study may very well benefit from an analysis taking into account the psychological processes regulating people's behavioral intentions and decisions. Within this broad framework, this contribution addresses several issues that currently seem to characterize the debate in the literature on neuroenhancement substances (NES) use. The first conceptual issue seeks to determine and define the "boundaries" of the phenomenon. The second issue concerns the empirical evidence on the prevalence of using certain substances for the purpose of NE. Finally, there is a debate around the ethical and moral implications of NE. Along these lines, the existing psychological research on NE has adopted mainly sociological and economic decision-making perspectives, greatly contributing to the psychological discourse about the phenomenon of NE. However, we argue that the existing psychological literature does not offer a common, explicit and integrated theoretical framework. Borrowing from the framework of doping research, we recommend the adoption of a social cognitive model for pursuing a systematic analysis of the psychological processes that dynamically regulate students' use of NES over time.

Work-related stress and cognitive enhancement among university teachers

BACKGROUND

Working conditions of academic staff have become increasingly complex and occupational exposure has risen. This study investigates whether work-related stress is associated with the use of prescription drugs for cognitive enhancement (CE).

METHODS

The study was designed around three web-based surveys (n1 = 1131; n2 = 936; n3 = 906) to which university teachers at four German universities were asked to respond. It assessed past CE-drug use and the willingness to use CE-drugs as factors influencing future use. Overlap among participants across the surveys allowed for analyses of stability of the results across time.

RESULTS

Our study suggests a currently very low prevalence of CE-drug use as well as a low willingness to use such drugs. The results showed a strong association between perceptions of work-related stress and all measures of CE-drug use (when controlling for potential confounding factors). They also showed that past use of CE-drugs increased participants' willingness to use them again in the future, as did lower levels of social support. Two different measures showed that participants' moral qualms against the use of CE-drugs decreased their probability of using them.

CONCLUSIONS

The results increase our knowledge about the prevalence of CE-drug use and our understanding of what motivates and inhibits the use of CE-drug.

Addressing the problem of ADHD medication as neuroenhancements

The prevalence of attention deficit hyperactivity disorder (ADHD) diagnoses is rising. ADHD is closely linked to its treatment with medications such as methylphenidate and amphetamines, which have popular appeal as neuroenhancement drugs by persons without a neurological disorder. The three main reasons for the increase in ADHD medication demand, production, and consumption are a) the inclusion of milder ADHD diagnoses; b) the vast marketing of ADHD medications by the pharmaceutical industry; and c) the illegal diversion of controlled ADHD medication to consumers seeking stimulants as neuroenhancements. Rapidly rising rates of any neurological disorder - especially a behaviorly-defined disorder closely linked to potent medications currently prescribed to more than 5% of the population - deserves ongoing scrutiny. Major social and ethical problems arise from vague-symptom medicalization, neurological disorder trivialization, medication overuse, and controlled substances diversion to healthy persons for nonmedical purposes. We argue against the 'spectrumization' of ADHD in an effort to curtail further diagnosis creep.

The implications of methylphenidate use by healthy medical students and doctors in South Africa

Background

The use of medical stimulants to sustain attention, augment memory and enhance intellectual capacity is increasing in society. The use of Methylphenidate for cognitive enhancement is a subject that has received much attention in the literature and academic circles in recent times globally. Medical doctors and medical students appear to be equally involved in the off-label use of Methylphenidate. This presents a potential harm to society and the individual as the long-term side effect profile of this medication is unknown.

Discussion

The implication of the use of Methylphenidate by medical students and doctors has not been fully explored. This article considers the impact of this use on the traditional role of medicine, society, the patient and suggests a way forward. We discuss the salient philosophy surrounding the use of cognitive enhancement. We query whether there are cognitive benefits to the use of Methylphenidate in healthy students and doctors and whether these benefits would outweigh the risks in taking the medication. Could these benefits lead to tangible outcomes for society and could the off label-use of Methylphenidate potentially undermine the medical profession and the treatment of patients? If cognitive benefits are proven then doctors may be coerced explicitly or implicitly to use the drug which may undermine their autonomy. The increased appeal of cognitive enhancement challenges the traditional role of medicine in society, and calls into question the role of a virtuous life as a contributing factor for achievement. In countries with vast economic disparity such as South Africa an enhancement of personal utility that can be bought may lead to greater inequities.

Summary

Under the status quo the distribution of methylphenidate is unjust. Regulatory governmental policy must seek to remedy this while minimising the potential for competitive advantage for the enhanced. Public debate on the use of cognitive enhancement is long overdue and must be stimulated. The use of Methylphenidate for cognitive enhancement is philosophically defendable if long-term research can prove that the risks are negligible and the outcomes tangible.

Performance enhancement, elite athletes and anti doping governance: comparing human guinea pigs in pharmaceutical research and professional sports

In light of the World Anti Doping Agency's 2013 Code Revision process, we critically explore the applicability of two of three criteria used to determine whether a method or substance should be considered for their Prohibited List, namely its (potential) performance enhancing effects and its (potential) risk to the health of the athlete. To do so, we compare two communities of human guinea pigs: (i) individuals who make a living out of serial participation in Phase 1 pharmacology trials; and (ii) elite athletes who engage in what is effectively 'unregulated clinical research' by using untested prohibited or non-prohibited performance enhancing substances and methods, alone or in combination. Our comparison sheds light on norms of research ethics that these practices exacerbate with respect to the concepts of multiplicity, visibility, and consistency. We argue for the need to establish a proper governance framework to increase the accountability of these unregulated research practices in order to protect the human guinea pigs in elite sports contexts, and to establish reasonable grounds for the performance enhancing effects, and the risks to the health of the athlete, of the methods and substances that might justify their inclusion on the Prohibited List.

Evaluating the drivers of and obstacles to the willingness to use cognitive enhancement drugs: the influence of drug characteristics, social environment, and personal characteristics

BACKGROUND

The use of cognitive enhancement (CE) by means of pharmaceutical agents has been the subject of intense debate both among scientists and in the media. This study investigates several drivers of and obstacles to the willingness to use prescription drugs non-medically for augmenting brain capacity.

METHODS

We conducted a web-based study among 2,877 students from randomly selected disciplines at German universities. Using a factorial survey, respondents expressed their willingness to take various hypothetical CE-drugs; the drugs were described by five experimentally varied characteristics and the social environment by three varied characteristics. Personal characteristics and demographic controls were also measured.

RESULTS

We found that 65.3% of the respondents staunchly refused to use CE-drugs. The results of a multivariate negative binomial regression indicated that respondents' willingness to use CE-drugs increased if the potential drugs promised a significant augmentation of mental capacity and a high probability of achieving this augmentation. Willingness decreased when there was a high probability of side effects and a high price. Prevalent CE-drug use among peers increased willingness, whereas a social environment that strongly disapproved of these drugs decreased it. Regarding the respondents' characteristics, pronounced academic procrastination, high cognitive test anxiety, low intrinsic motivation, low internalization of social norms against CE-drug use, and past experiences with CE-drugs increased willingness. The potential severity of side effects, social recommendations about using CE-drugs, risk preferences, and competencies had no measured effects upon willingness.

CONCLUSIONS

These findings contribute to understanding factors that influence the willingness to use CE-drugs. They support the assumption of instrumental drug use and may contribute to the development of prevention, policy, and educational strategies.

Impact of contextual factors and substance characteristics on perspectives toward cognitive enhancement

Enhancing cognitive performance with substances–especially prescription drugs–is a fiercely debated topic among scholars and in the media. The empirical basis for these discussions is limited, given that the actual nature of factors that influence the acceptability of and willingness to use cognitive enhancement substances remains unclear. In an online factorial survey, contextual and substance-specific characteristics of substances that improve academic performance were varied experimentally and presented to respondents. Students in four German universities rated their willingness to use and moral acceptance of different substances for cognitive enhancement. We found that the overall willingness to use performance enhancing substances is low. Most respondents considered the use of these substances as morally unacceptable. Situational influences such as peer pressure, policies concerning substance use, relative performance level of peers, but also characteristics of the substance, such as perceptions of substance safety, shape the willingness and acceptability of using a substance to enhance academic performance. Among the findings is evidence of a contagion effect meaning that the willingness was higher when the respondents have more CE drug users in their social network. We also found deterrence effects from strong side effects of using the substance, as well as from policy regulations and sanctions. Regulations might activate social norms against usage and sanctions can be seen as costly to users. Moreover, enhancement substances seem to be most tempting to low performers to catch up with others compared to high performers. By identifying contextual factors and substance characteristics influencing the willingness and acceptability of cognitive enhancers, policy approaches could consider these insights to better manage the use of such substances.

The rationale for consuming cognitive enhancement drugs in university students and teachers

Cognitive enhancement (CE) is the pharmaceutical augmentation of mental abilities (e.g., learning or memory) without medical necessity. This topic has recently attracted widespread attention in scientific and social circles. However, knowledge regarding the mechanisms that underlie the decision to use CE medication is limited. To analyze these decisions, we used data from two online surveys of randomly sampled university teachers (N = 1,406) and students (N = 3,486). Each respondent evaluated one randomly selected vignette with regard to a hypothetical CE drug. We experimentally varied the characteristics of the drugs among vignettes and distributed them among respondents. In addition, the respondent's internalization of social norms with respect to CE drug use was measured. Our results revealed that students were more willing to enhance cognitive performance via drugs than university teachers, although the overall willingness was low. The probability of side effects and their strength reduced the willingness to use CE drugs among students and university teachers, whereas higher likelihoods and magnitudes of CE increased this propensity. In addition, the internalized norm against CE drug use influenced decision making: Higher internalization decreased the willingness to use such medications. Students' internalized norms more strongly affected CE abstinence compared with those of university teachers. Furthermore, internalized norms negatively interacted with the instrumental incentives for taking CE medication. This internalization limited the influence of and deliberation on instrumental incentives. This study is the first to provide empirical evidence regarding the importance of social norms and their influence on rational decision making with regard to CE. We identified previously undiscovered decision-making patterns concerning CE. Thus, this study provides insight into the motivators and inhibitors of CE drug use. These findings have implications for contending with CE behavior by highlighting the magnitude of potential side effects and by informing the debate regarding the ethics of CE use.

Cognitive test anxiety and cognitive enhancement: the influence of students' worries on their use of performance-enhancing drugs

This online panel study (n(t)(1) = 5,882; n(t)(2) = 3,486 (randomly selected)) used multiple metrics to assess the prevalence of the nonmedical use of prescription medication for enhancing cognitive performance among German university students in 2010. Rare events logistic regression revealed that increased cognitive test anxiety increased the prevalence of medication use over various time windows. Negative binomial regression models showed that the higher the cognitive test anxiety, the higher the use frequencies were during the previous six months. The models controlled for expected side effects, risk attitudes, self-attributed competencies, prior medication use, sex, and age. We also discuss the study's implications.

Prohibition or coffee shops: regulation of amphetamine and methylphenidate for enhancement use by healthy adults

This article analyzes appropriate public policies for enhancement use of two most important stimulant drugs: Ritalin (methylphenidate) and Adderall (mixed amphetamine salts). The author argues that appropriate regulation of cognition enhancement drugs cannot be a result of a general discussion on cognitive enhancements as such, but has to be made on a case-by-case basis. Starting from the recently proposed taxation approach to cognition enhancement drugs, the author analyzes available, moderately permissive models of regulation. After a thorough analysis of relevant characteristics of methylphenidate and amphetamine, the author concludes that a moderately liberal permissive regulation of enhancement use by healthy adults might be appropriate for extended release forms of methylphenidate. However, due to their danger profile, amphetamine and instant release forms of methylphenidate should not be made readily available to healthy adults and would need to be prohibited.

Transcranial magnetic stimulation, deep brain stimulation and personal identity: ethical questions, and neuroethical approaches for medical practice

Neurotechnology provides means to engage micro- and macrostructural networks of the brain to both mitigate the manifestations of several neurological and psychiatric disorders, and alter cognition and motoric activity. Such capacity also generates questions of how these interventions may affect personal identity. This paper discusses the ethical implications regarding changes to personal identity that arise from the therapeutic use of transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS) technologies. In addition, we raise the question of whether changes in personal identity, as a side effect of these interventions, are ethically acceptable and whether such alterations of personality foster patients' sense of well-being and autonomy. First, we provide a series of case vignettes that afford an overview of the ways that various neurological interventions can affect personal identity. Second, we offer a brief working definition of personal identity in order to delineate an ethical framework that we deem necessary for the responsible use of neurostimulation technologies. In so doing, we argue that neurostimulation therapy, as a doctoring act, should be directed, and adherent to goals of restoring and/or preserving patients' personal identity. To this end, we offer an ethical framework that we believe enables sound decisions about the right and good use of TMS and DBS.

Does Memory Modification Threaten Our Authenticity?

One objection to enhancement technologies is that they might lead us to live inauthentic lives. Memory modification technologies (MMTs) raise this worry in a particularly acute manner. In this paper I describe four scenarios where the use of MMTs might be said to lead to an inauthentic life. I then undertake to justify that judgment. I review the main existing accounts of authenticity, and present my own version of what I call a "true self" account (intended as a complement, rather than a substitute, to existing accounts). I briefly describe current and prospective MMTs, distinguishing between memory enhancement and memory editing. Moving then to an assessment of the initial scenarios in the light of the accounts previously described, I argue that memory enhancement does not, by its very nature, raise serious concerns about authenticity. The main threat to authenticity posed by MMTs comes, I suggest, from memory editing. Rejecting as inadequate the worries about identity raised by the President's Council on Bioethics in Beyond Therapy, I argue instead that memory editing can cause us to live an inauthentic life in two main ways: first, by threatening its truthfulness, and secondly, by interfering with our disposition to respond in certain ways to some past events, when we have reasons to respond in such ways. This consideration allows us to justify the charge of inauthenticity in cases where existing accounts fail. It also gives us a significant moral reason not to use MMTs in ways that would lead to such an outcome.

Philosophical and ethical issues at the forefront of neuroscience and genetics: an overview for psychiatrists

This review has touched upon some of the major ethical issues surrounding emerging technologies in neuroscience and genetics. Although at first glance these issues may seem somewhat peripheral to the clinical practice of psychiatry, we suggest that they may have unanticipated effects upon the care of patients with mental illness. Certainly, the philosophical issues surrounding free will are of tremendous consequence to persons who commit crimes while suffering severe symptoms of mental illness. In addition, the opening up of a lucrative new "enhancement" market for the sale of new therapies could divert commercial resources away from the development of therapies for mental illness, although it is also possible that some enhancements will have secondary benefits as treatments for disease. Social acceptance of enhancement therapies could have a beneficial, normalizing effect on public attitudes toward those who receive mental health treatment. On the other hand, a moral backlash against enhancements as "quick fixes" that deprive individuals of authenticity could have a secondary effect of increasing the stigma of mental health treatment. For all of these reasons, it has become increasingly important for psychiatrists to be informed about and active participants in the public conversation about neuroethics. Psychiatric patients appear to have much at stake in these ethical debates, and psychiatrists have valuable expertise to offer as professionals with intimate knowledge of the human mind, its limitations, and its potential.