Knowledge, Experiences and Views of German University Students Toward Neuroenhancement: An Empirical-Ethical Analysis

Public Views on Whether the Use of Pharmaceutical Neuroenhancements Should Be Allowed

BACKGROUND AND OBJECTIVES

Some individuals are using drugs to try to enhance cognitive and social-affective functioning and asking physicians for off-label prescriptions for neuroenhancement (e.g., stimulants). Several medical societies released guidance on prescribing neuroenhancers, some of which refer to potential societal effects of neuroenhancement (e.g., distributive justice), besides risks and benefits to users. Which institutions (e.g., medical societies, government, universities) should make decisions on allowing neuroenhancement and whether they should consider potential societal effects are unclear. We examined whether and how much support for allowing pharmaceutical neuroenhancers was influenced by the institution and potential individual and societal effects of neuroenhancers.

METHODS

We conducted a discrete-choice experiment using a constructed representative sample of the US adult public. Multinomial logit models were used to analyze the data.

RESULTS

Participants (n = 927) demographically resembled the US population. Risks of serious side effects (OR 0.20, CI 0.18-0.22) and a lack of benefits for users (OR 0.31, CI 0.26-0.38) had the largest negative effect on participants' support for allowing neuroenhancers. A risk of mild side effects had a moderate negative effect on participants' support for allowing neuroenhancers (OR 0.67, CI 0.62-0.74) and the prospect of more meaningful, long-lasting benefits for users a moderate positive effect (OR 1.74, CI 1.61-1.87). Positive or negative effects of neuroenhancers on the average well-being of people in society and on equality had moderate effects on participants' support for allowing neuroenhancers. For example, the odds of participants' support for allowing enhancers with a negative effect on societal well-being were around half (OR 0.45, CI 0.40-0.50) and the odds of allowing enhancers that worsen inequality were approximately 40% lower compared with enhancers without such effects (OR 0.62, CI 0.55-0.71). The odds of participants allowing neuroenhancers were slightly (10%) lower if enhancers reduced users' authenticity (OR 0.90, CI 0.84-0.97). The institution regulating neuroenhancers and neuroenhancers providing users with an unfair advantage did not affect participants' decisions.

DISCUSSION

When presented with both individual and societal considerations, the public seems to support medical societies and other institutions making policy decisions about neuroenhancers based on risks and benefits for users, as well as, but to a lesser extent, effects on equality and societal well-being.

"In the spectrum of people who are healthy": Views of individuals at risk of dementia on using neurotechnology for cognitive enhancement

Neurotechnological cognitive enhancement has become an area of intense scientific, policy, and ethical interest. However, while work has increasingly focused on ethical views of the general public, less studied are those with personal connections to cognitive impairment. Using a mixed-methods design, we surveyed attitudes regarding implantable neurotechnological cognitive enhancement in individuals who self-identified as having increased likelihood of developing dementia (n=25; 'Our Study'), compared to a nationally representative sample of Americans (n=4726; 'Pew Study'). Participants in Our Study were additionally shown four videos showcasing hypothetical neurotechnological devices designed to enhance different cognitive abilities and were interviewed for more in-depth responses. Both groups expressed comparable degrees of worry and acknowledgement of potential ethical ramifications (all ps>0.05). Compared to the Pew Study, participants in Our Study expressed slightly higher desire (p<0.01), as well as higher acknowledgment for potential impacts on productivity (p<0.05). Ultimately, participants in Our Study were more likely to deem the device morally acceptable (56%; compared to Pew Study, 25.2%; p=0.0001). Interviews conducted in Our Study allowed participants to supply additional nuance and reasoning to survey responses, such as giving examples for increased productivity, perceived downsides of memory enhancement, or concerns regarding potentially resulting inequality. This study builds upon and adds to the growing focus on potential ethical issues surrounding neurotechnological cognitive enhancement by centering stakeholder perspectives, highlighting the need for inclusive research and consideration of diverse perspectives and lived experiences to ensure inclusive dialogue that best informs ethical and policy discussions in this rapidly advancing field.

Students' use of caffeine, alcohol, dietary supplements, and illegal substances for improving academic performance in a New Zealand university

This study aimed to describe patterns of use and attitudes towards a broad variety of substances for improving academic performance at a New Zealand university. 685 students (from 1800 invited) completed an online questionnaire (38% response rate). They were asked about their lifetime and current substance use for improving academic performance, as well as their reasons for use, attitudes and perceptions of: caffeine, alcohol, dietary supplements, prescription stimulants, other prescription substances, and illicit substances. 80% (95% CI: 76.3, 82.5) reported ever using any substance to help improve academic performance, mainly to stay awake and improve concentration. Caffeine (70%, 95% CI: 66.3, 73.3) and dietary supplements (32%, 95% CI: 28.3, 35.5) were most commonly used. 4% (95% CI: 2.7, 5.9) reported use of prescription stimulants, mostly methylphenidate, and another 4% (95% CI: 2.7, 5.9) reported using illicit substances for improving academic performance. Users of prescription stimulants were more likely than non-users to believe that they were safe, morally acceptable, and that they should be available legally for enhancing academic performance. We close with discussions on broadening the focus of substances for improving academic performance in public health debates. Further qualitative research from small countries is also needed to move towards a place-based approach for clarifying ethical implications, inform policy in universities, and understand how injustices are created through the use of and ability to purchase different substances.

Attitudes of medicine, pharmacy, and dentistry students about psychostimulant use to enhance cognition

INTRODUCTION

The use of psychostimulant drugs to increase academic success is common among young people. There is no study examining this issue in Turkish population. In this study, the prevalence, attitudes, knowledge, and ethical evaluations of Pharmacological Cognitive Enhancement (PCE) in university students were investigated.

METHOD

A structured online survey was carried out with 1148 undergraduate and postgraduate (master, PhD and residency) students in different faculties of Medicine, Dentistry and Pharmacy in Turkey. Comparisons between groups, correlation and regression analysis about associated variables were made.

RESULTS

The general prevalence of PCE in our study was found to be 7.4%. The highest prevalence was seen in the faculty of medicine (8.4%), among the residency students (15.5%). There was no significant difference prevalence of PCE between the faculties. Education level, smoking, study performance satisfaction, and knowledge level were found to be factors associated with PCE. Around 40% of PCE users stated that they used it with the recommendation of their friends. PCE users had a lower perception of harm and risk, and rated the use of it as more acceptable and normal behaviour.

CONCLUSION

PCE is a method used by young with high knowledge, low study performance satisfaction, to increase their academic success, especially during exam periods. Peer effect is an important factor in increasing prevalence.

Just "Like Coffee" or Neuroenhancement by Stimulants?

Introduction: Pharmacological neuroenhancement (PN) is a topic of increasing importance and prevalence among students. However, there is a lack of differentiating PN substances, according to their psychoactive effects. In particular, there is a lack of data about PN by caffeinated drinks, even if coffee is a common and broadly used Neuroenhancer because of its cognitively enhancing effects regarding wakefulness, alertness and concentration.

Materials and Methods: A web-survey was developed for German students and alumni about the non-medical use of caffeine for PN contained questions about coffee, caffeinated drinks and energy drinks, caffeine pills and methylxanthine tea regarding frequency and further contextual factors.

Results: Six hundred and eighty-three participants completed the survey. Nearly all participants knew about PN (97.7%). 88.1% admitted using some over-the-counter substances. For PN purposes, coffee was used by 72.9% followed by energy drinks (68.2%) and cola drinks (62.4%). Methylxanthine containing tea was used for PN purposes, too (black tea 52.3%, green tea 51.7%). 1.8% admitted using illegal substances or prescription drugs, too.

Discussion: Using legal methylxanthine containing drinks for PN seems to be extremely common with coffee and energy drinks being the preferred substances, while illegal and prescription drugs are only minimally used. Further studies should investigate the awareness of methylxanthine containing drinks as well as its character to be a flavoring drink or a neuroenhancer.

How pills undermine skills: Moralization of cognitive enhancement and causal selection

Despite the promise to boost human potential and wellbeing, enhancement drugs face recurring ethical scrutiny. The present studies examined attitudes toward cognitive enhancement in order to learn more about these ethical concerns, who has them, and the circumstances in which they arise. Fairness-based concerns underlay opposition to competitive use-even though enhancement drugs were described as legal, accessible and affordable. Moral values also influenced how subsequent rewards were causally explained: Opposition to competitive use reduced the causal contribution of the enhanced winner's skill, particularly among fairness-minded individuals. In a follow-up study, we asked: Would the normalization of enhancement practices alleviate concerns about their unfairness? Indeed, proliferation of competitive cognitive enhancement eradicated fairness-based concerns, and boosted the perceived causal role of the winner's skill. In contrast, purity-based concerns emerged in both recreational and competitive contexts, and were not assuaged by normalization.

Medical Students' Attitudes Towards Pharmacological Cognitive Enhancement With Methylphenidate

OBJECTIVE

The aim of this study was to assess medical students' perception of pharmacological cognitive enhancement (PCE) with methylphenidate and to determine whether this perception differs between junior and senior medical students.

METHODS

The second and fifth year medical student groups of 2017 at a specific university completed self-administered questionnaires in order to investigate if there were a difference in their attitudes towards methylphenidate use for PCE.

RESULTS

A total of 353 students were included as follows: 135 second year and 218 fifth year students. Fifth year students were more aware of PCE with methylphenidate than second year students (94% versus 87%; p value = 0.02). Many students (second year = 86%; fifth year = 71%; p value = 0.2469) were of the opinion that methylphenidate could enhance academic performance. Sixty-six percent of all the students were concerned about the fairness of PCE; 93% were concerned about the harmfulness of methylphenidate. There were no statistical significant differences in the attitudes towards methylphenidate use for PCE between the two groups of junior and senior students.

CONCLUSION

In both groups, the majority of students were against the use of methylphenidate for PCE in students without attention deficit and hyperactivity disorder. Their attitudes regarding the use of methylphenidate for non-medical purposes did not differ significantly. Addressing the topic of PCE with medical students is essential, and the impact on their practice can be an important direction for future research.

Public Opinion on Cognitive Enhancement Varies across Different Situations

People vary widely in their acceptance of the use of pharmacological cognitive enhancement (CE). We tested the hypothesis that the acceptability of CE is malleable, by varying the context in which CE use takes place, by framing the use of CE with positive and negative metaphors, and by distinguishing between self and other CE use. 2,519 US-based participants completed 2 surveys using Amazon's Mechanical Turk. First, participants responded to vignettes describing a fictional character, which varied by framing metaphor (Pandora's box that releases brain performance vs. key that unlocks brain potential), role/setting (student/educational vs. employee/professional), and activity type (blue vs. white collar). Second, participants viewed personalized vignettes describing their own situations. Across both surveys, participants generally found CE use more acceptable for employees than students, while the effects of framing metaphors were unreliable and smaller than previously reported. People were more accepting of CE use by others than by themselves. Participants also found CE use more acceptable if more peers used CE, the environment was less competitive, and authority figures encouraged CE use. Our findings suggest that opinions about CE are indeed malleable, and concerns that peer pressure, the influence of authority figures, and competition might affect CE use are not unfounded.

Pharmakologisches Neuroenhancement in Deutschland

Hintergrund Die Angaben zur Verbreitung des pharmakologischen Neuroenhancements (pNE) in Deutschland variieren stark. Der Beitrag diskutiert, inwieweit dieser Umstand methodischen Aspekten der Prävalenzstudien geschuldet sein könnte.

Methode Der Beitrag gibt einen Überblick zum aktuellen Forschungsstand und beleuchtet methodische Probleme der Prävalenzforschung in Deutschland.

Ergebnisse Die Prävalenzangaben variieren je nach Erhebungsmethode, abgefragtem Zeitpunkt der Einnahme und untersuchten Zielgruppen und Stoffen bei verschreibungspflichtigen und illegalen Substanzen zwischen einem und 39%. Für frei erhältliche Mittel werden z. T. höhere Prävalenzen berichtet. Es lassen sich 4 große methodische Probleme der Forschung identifizieren: 1.) Die Heterogenität der Definitionen, 2.) die Heterogenität der Befragungsmethoden und die Qualität der Stichproben(ziehungen), 3.) Defizite bei der Frageformulierung, 4.) das Fehlen wichtiger Angaben in den zugehörigen Veröffentlichungen.

Schlussfolgerung Verlässliche Aussagen zur Verbreitung von pNE in Deutschland sind schwierig. Zwischen den Untersuchungen bestehen inhaltlich und methodisch große Unterschiede, die Ergebnisse lassen sich nur bedingt vergleichen. Notwendig sind regelmäßige bevölkerungsrepräsentative Erhebungen auf Basis einheitlicher Definitionen.

Pharmacological cognitive enhancement: Examining the ethical principles guiding college students' abstention

Objectives

To understand the ethical principles guiding college students' abstention from pharmacological cognitive enhancement (PCE), and to determine the correlates associated with endorsing different principles.

Design

One-stage cluster sampling was used to implement a paper-based survey among undergraduate students attending one university in the U.S. Thematic analysis was used to explore the ethical principles guiding PCE abstention. Multivariate logistic regression analyses were used to examine sociodemographic correlates associated with endorsed ethical principles.

Participants

Of the 499 eligible students who completed the survey (student response proportion: 94.7%), 259 students had a negative attitude towards PCE, did not engage in PCE, and provided reasons for abstention.

Results

The thematic analysis resulted in the identification of eight themes, with respondents often endorsing more than one theme per response. The three themes most endorsed were non-malfeasance (i.e., avoiding PCE to prevent harm), disapproval of drugs (i.e., a moral opposition to substance use) and dosage beneficence (i.e., adhering to dosage guidance to promote health). The sociodemographic correlates associated with endorsing each theme varied across themes.

Conclusions

Students abstain from PCE for a multitude of reasons, many of which are guided by ethical principles. These findings may be incorporated into future prevention programming messages.

Developing expertise, customising sleep, enhancing study practices: exploring the legitimisation of modafinil use within the accounts of UK undergraduate students

Introduction and aim: Increasing numbers of students are reportedly using prescription medications to enhance cognition. This study aimed to generate qualitative data on UK students' understandings and perspectives of the risks and benefits surrounding so-called 'study drugs' (particularly, modafinil). Design and methods: Fifteen undergraduate students studying biomedical science subjects were interviewed about their perspectives on study drugs. Interviews were recorded and transcribed for thematic analysis. Users and non-users were included in the sample. Results: The prescription status and comparisons to other legal and illicit stimulants informed accounts of the (lack of) risks associated with study drugs, legitimising use. The customisation of sleep(iness) and wakefulness was described as a key benefit of study drug use. Drivers of use related to university pressures and desires to increase productivity. In periods of heightened stress, such as examinations, students reported altered practices and perspectives on risk. Discussion and conclusions: We noted the contextual nature of students' use and risk appraisals, with fluctuating social contexts and pressures over time being capable of altering prior assessments and current practices (including the legitimisation of study drug consumption). Further, we highlighted the degree to which students leveraged their biomedical and experiential expertise to account for drug consumption.

Attitudes Toward Cognitive Enhancement: The Role of Metaphor and Context

The widespread use of stimulants among healthy individuals to improve cognition has received growing attention; however, public attitudes toward this practice are not well understood. We determined the effect of framing metaphors and context of use on public opinion toward cognitive enhancement. We recruited 3,727 participants from the United States to complete three surveys using Amazon's Mechanical Turk between April and July 2017. Participants read vignettes describing an individual using cognitive enhancement, varying framing metaphors (fuel versus steroid), and context of use (athletes versus students versus employees). The main outcome measure was the difference in respondent-assigned level of acceptability of the use of cognitive enhancement by others and by themselves between the contrasting vignettes. Participants were more likely to support the use of cognitive enhancement by others than by themselves and more when the use of enhancement by others was framed with a fuel metaphor than with a steroid metaphor. Metaphoric framing did not affect participants' attitudes toward their own use. Participants supported the use of enhancement by employees more than by students or athletes. These results are discussed in relation to existing ethical and policy literature.

Cannabis for Cognitive Enhancement as a New Coping Strategy? Results From a Survey of Students at Four Universities in Germany

BACKGROUND

Cognitive Enhancement (CE) is often discussed in relation to stimulant drugs, such as amphetamines (AMPH). However, there is some evidence that cannabis (CAN) can be used for CE.

OBJECTIVE

This study compares the knowledge, prevalence, and perceived effects of and factors associated with the knowledge of or use of CAN versus AMPH for CE among undergraduate students at four German universities.

METHODS

A survey was taken of 1,538 students at four German universities. It investigated their knowledge and use of CAN and AMPH for CE as well as associated factors. Descriptive and analytic (Mann-Whitney-U test, Fisher's exact test, logistic regression) statistics were obtained using SPSS.

RESULTS

Responses were obtained from 1,026 participants (57.2%) at three universities from the Universitätsallianz Metropole Ruhr (UAR) (Bochum, Dortmund, Duisburg-Essen) and 512 respondents (68.3%) in Mainz. We observed lifetime prevalence rates of 3.5% for the use of CAN and 2.1% for the use of AMPH for the purpose of CE. CAN users perceived pressure to perform as more of a burden than AMPH users (mean: 3.2, CAN users: 4.7, AMPH: 2.9; p =.042). CAN users used the substances for studying for exams significantly less often than AMPH users (p =.025), and CAN users perceived less of an enhancing effect of the drug compared to AMPH users (p <.001).

CONCLUSIONS

A considerable number of students report having used CAN for CE. However, our research indicates differences in perceptions and experiences of CE between CAN and AMPH users. Further research on the role of CAN for CE and conceptual analyses to differentiate between different understandings of CE are warranted.

From 'Hard' Neuro-Tools to 'Soft' Neuro-Toys? Refocussing the Neuro-Enhancement Debate

Since the 1990’s, the debate concerning the ethical, legal and societal aspects of ‘neuro-enhancement’ has evolved into a massive discourse, both in the public realm and in the academic arena. This ethical debate, however, tends to repeat the same sets of arguments over and over again. Normative disagreements between transhumanists and bioconservatives on invasive or radical brain stimulators, and uncertainties regarding the use and effectivity of nootropic pharmaceuticals dominate the field. Building on the results of an extensive European project on responsible research and innovation in neuro-enhancement (NERRI), we observe and encourage that the debate is now entering a new and, as we will argue, more realistic and societally relevant stage. This new stage concerns those technologies that enter the market as ostensibly harmless contrivances that consumers may use for self-care or entertainment. We use the examples and arguments of participants in NERRI debates to describe three case studies of such purportedly innocent ‘toys’. Based upon this empirical material, we argue that these ‘soft’ enhancement gadgets are situated somewhere in the boundary zone between the internal and the external, between the intimate and the intrusive, between the familiar and the unfamiliar, between the friendly and the scary and, in Foucauldian terms, between technologies of the self and technologies of control. Therefore, we describe their physiognomy with the help of a term borrowed from Jacques Lacan, namely as “extimate” technologies.

Prevalence of and motives for pharmacological neuroenhancement in Switzerland--results from a national Internet panel

AIMS

To estimate the prevalence of self-reported pharmacological neuroenhancement (PNE) with prescription or recreational drugs among the Swiss general population and correlates of PNE.

DESIGN

A population-based cross-sectional study using a self-administered online survey.

SETTING

A telephone-recruited highly representative internet panel in Switzerland.

PARTICIPANTS

A total of 10,171 Swiss employees and students (unweighted n = 10,084) aged 15-74 years (mean age: 39.1 ± 13.3; 46.6% female).

MEASUREMENTS

Self-reported life-time, past-year and past-month use of prescription or recreational drugs for PNE, motives for use and correlates of PNE, including socio-demographic, health and recreational drug use characteristics.

FINDINGS

The life-time prevalence of PNE was 4.0% [95% confidence interval (CI) = 3.62, 4.38], and the past-year prevalence was 2.1% (95% CI = 1.82, 2.38). Life-time pharmacological mood enhancement (3.1%; 95% CI = 2.76, 3.44) was more prevalent than pharmacological cognitive enhancement (1.4%; 95% CI = 1.17, 1.63). Fifty-four participants reported both (0.5%; 95% CI = 0.36, 0.64). PNE was associated with studying rather than full-time [odds ratio (OR) = 0.35; 95% CI = 0.21, 0.57] or part-time employment (OR = 0.39; 95% CI = 0.23, 0.67), stress (OR = 1.51 95% CI = 1.31, 1.75), cocaine (OR = 2.40; 95% CI = 1.51, 3.82) and amphetamine use (OR = 2.44; CI 95% = 1.37, 4.33), diagnosis of a mental disorder (OR = 4.26; 95% CI = 3.14, 5.80), and perceived poor health (OR = 0.76; 95% CI = 0.64, 0.90).

CONCLUSIONS

Taking prescription or recreational drugs for pharmacological neuroenhancement is rare among Swiss employees and students (4.0%). Pharmacological mood enhancement (3.1%) is more prevalent than direct pharmacological cognitive enhancement (1.4%).

The is and ought of the Ethics of Neuroenhancement: Mind the Gap

Ethical perspectives on the use of stimulants to enhance human cognitive performance (neuroenhancement) are polarized between conservative and liberal theories offering opposing advice on whether individuals have a right to use neuroenhancers and what the social outcomes of neuroenhancement might be. Meanwhile, empirical evidence shows modest prevalence and guarded public attitudes toward the neuroenhancement use of stimulants. In this Perspective, we argue that the dissonance between the prescriptions of ethical theories (what ought to be) and empirical evidence (what is) has impaired our understanding of neuroenhancement practices. This dissonance is a result of three common errors in research on the ethics of neuroenhancement: (1) expecting that public perspectives will conform to a prescriptive ethical framework; (2) ignoring the socio-economic infrastructures that influence individuals' decisions on whether or not to use neuroenhancement; and (3) overlooking conflicts between fundamental ethical values namely, safety of neuroenhancement and autonomy. We argue that in order to understand neuroenhancement practices it is essential to recognize which values affect individual decisions to use or refuse to use neuroenhancement. Future research on the ethics of neuroenhancement should assess the morally significant values for stakeholders. This will fill the gap between what ought to be done and what is done with an improved understanding of what can be done within a particular context. Clarifying conflicts between competing moral values is critical in conducting research on the efficacy of substances putatively used for neuroenhancement and also on neuroenhancement practices within academic, professional and social environments.