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Cognitive privilege is a civil right… or something

2017/08/06

The impact of neuroscience on society: cognitive enhancement in neuropsychiatric disorders and in healthy people

Abstract

In addition to causing distress and disability to the individual, neuropsychiatric disorders are also extremely expensive to society and governments. These disorders are both common and debilitating and impact on cognition, functionality and wellbeing. Cognitive enhancing drugs, such as cholinesterase inhibitors and methylphenidate, are used to treat cognitive dysfunction in Alzheimer’s disease and attention deficit hyperactivity disorder, respectively. Other cognitive enhancers include specific computerized cognitive training and devices. An example of a novel form of cognitive enhancement using the technological advancement of a game on an iPad that also acts to increase motivation is presented. Cognitive enhancing drugs, such as methylphenidate and modafinil, which were developed as treatments, are increasingly being used by healthy people. Modafinil not only affects ‘cold’ cognition, but also improves ‘hot’ cognition, such as emotion recognition and task-related motivation. The lifestyle use of ‘smart drugs’ raises both safety concerns as well as ethical issues, including coercion and increasing disparity in society. As a society, we need to consider which forms of cognitive enhancement (e.g. pharmacological, exercise, lifelong learning) are acceptable and for which groups (e.g. military, doctors) under what conditions (e.g. war, shift work) and by what methods we would wish to improve and flourish.

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Summary and conclusion

In summary, these studies suggest that cognitive enhancers such as smart drugs and devices have the potential to provide benefits in healthy people, although the extent and specificity (which intervention affects which function and is best applied in which situation) are still under investigation. Other questions such as the safety of regular use in healthy people and, even more importantly, the potential effects on still-developing brains when used in healthy children and adolescents require more research [5,135,137].

In addition to safety issues, there are also ethical concerns. The exact numbers of healthy users of prescription drugs with the intention to enhance cognition are unknown, with estimates in the general population of less than 5%, although in some studies in students, between 10% and 20% of the students reported to have used prescription drugs within the past year, without strong differences between the US and Europe [110,138142]. One study in a small competitive college reported use within the last year in more than 30% of the students [143]. However, the prescription rates of stimulants in England have been rising steadily from 220 000 in 1998 to 418 300 in 2004. The global market share of modafinil, licensed in the UK for narcolepsy and excessive fatigue and sleepiness in certain chronic medical conditions, was more than $700 million per year [144], with an estimated ‘off-label’ use of around 90% [145]. In the lay press, modafinil has also gained a lot of attention as a pill that can boost brain power, which reflects the interest of the public in pharmacological enhancement of cognitive abilities such as planning and problem solving. These numbers raise the question as to why healthy people are using cognitive enhancing drugs. Some studies in college students in the USA have asked this question, and most students gave ‘improving intellectual performance’, ‘being more efficient on academic assignments’, ‘improving concentration’ and ‘being able to study longer’ as motives, with only a few reporting recreational ones [110]. This matches a report of the Academy of Medical Sciences that a small percentage increment in performance can lead to significant improvements in functional outcome; it is conceivable that a 10% improvement in memory score could lead to an improvement in an A-level grade or degree class [146]. Therefore, many students are using cognitive enhancing drugs to ‘get the competitive edge’ over other students in exam situations. It might have been this consideration that made Duke University prohibit the use of prescription drugs by students without an authorized prescription. Duke University’s website specifies the ‘unauthorized use of prescription medication to enhance academic performance’ as cheating in the category ‘academic dishonesty’ of their academic conduct policy [147].

Furthermore, particularly modafinil seems to affect motivation in a manner that makes unappealing tasks more appealing and therefore they can be undertaken and completed more easily. In other words, overall task-related pleasure is increased by modafinil [113]. This increase in motivation is task-specific, and not a general stimulating effect [113]. A third reason reported is reducing the effects of jet-lag and staying awake and alert for longer periods of time.


Further considerations

As responsible scientists and clinicians in the field of neuroscience and mental health, we need to consider how our discoveries and inventions will affect society [148150]. In the case of pharmacological cognitive enhancement, there are many people with neuropsychiatric disorders who could benefit greatly from these drugs. In the development of the field of novel pharmacological cognitive enhancers, we must gain maximum benefits with minimum harm to the individual and to society as a whole. However, ethical considerations of cognitive enhancement in healthy people are more complex, ranging from potential benefits in surgeons, shift workers, military, air traffic controllers and other fields where constant high performance is essential, to fears of coercion [151] and competitive pressure by peers, as well as increasing inequality with access depending on wealth and also cheating (see above, academic dishonesty). These ‘smart drugs’ may alter the future of work as we know it, particularly where shift work, jet lag and high-risk decisions may compromise performance [152]. On the other hand, as detailed above, scientific knowledge about the specific effects and side effects in the healthy population, particularly with long-term use, is still limited. Therefore, we need collaboration between scientists, pharmaceutical companies and governmental regulators to develop improved substances, get them trialled, tested and licensed. With this knowledge, neuroscientists together with social scientists, philosophers, ethicists and society should actively discuss the ethical and moral consequences of cognitive enhancement.

© 2015 The Authors. Published by the Royal Society under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/4.0/, which permits unrestricted use, provided the original author and source are credited.

(Edited excerpt)

Read more…

Sahakian, Barbara J., Annette B. Bruhl, Jennifer Cook, Clare Killikelly, George Savulich, Thomas Piercy, Sepehr Hafizi et al. “The impact of neuroscience on society: cognitive enhancement in neuropsychiatric disorders and in healthy peoplePhil. Trans. R. Soc. B 370, no. 1677 (2015): 20140214.

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