A recent Commentary in the international science journal NATURE (11 December 2008, vol 456, p.702)\u00a0 discussed the science and ethics of the use of cognitive-enhancing drugs by the healthy.\u00a0\u00a0 As the article pointed out, substances believed to help people control attention, remain alert when working at night or extra house, and learn faster\/better are now in widespread off-label use–used by those who do not have the diagnoses for which these substances were developed.<\/p>\n
Coercion–pressure to use these substances even if the individual doesn’t want to–is already being applied (for instance, by the Armed Forces for the use of certain stimulants, and by teachers who\u00a0 believe a child will be less trouble in the classroom if put on Ritalin) and employers began to looking at the possibility of enhancing work performance with drugs some years ago.\u00a0\u00a0 Since coercion by an employer is one of the plot drivers in The Speed of Dark<\/strong> it seemed like a good topic for this blog.<\/p>\n What is “cognitive enhancement” and what kinds of issues should be considered when anyone (disabled or not) faces a decision about the use of pharmacological or any other method of “enhancement?<\/p>\n <\/p>\n The term “cognitive enhancement” is used loosely to cover any of the following:\u00a0 maintaining alertness, including preventing sleep, directing\/controlling attention,\u00a0 controlling behavior (when behavior problems are believed to relate to distractibility or obsessive\/compulsiveness),\u00a0 increase memory, etc.\u00a0\u00a0 No one is yet suggesting a “smart pill” to increase IQ twenty points (well–not in this article anyway!) but as more is learned about the biochemistry of sensory processing, memory, learning, and behavior more specific interventions can and will be attempted.<\/p>\n If it were available, there are cognitive enhancements I’d like to have.\u00a0 I have a problem with face recognition, called prosopagnosia…I fail to recognize people I’ve just met (very embarrassing on a boat trip last spring!) and sometimes think strangers are old friends.\u00a0\u00a0 (I remember clothes and hairstyles–just not faces.\u00a0\u00a0 So when the person next to me in choir showed up with a new hair-style–I didn’t know who that was until she spoke.)\u00a0\u00a0 A pill to make my face-recognition module work?\u00a0 Sure.<\/p>\n Maybe.<\/p>\n What’s worrisome is that we do not know what the long-term effects of fiddling with\u00a0 the brain’s biochemistry is, and what little we do know gives cause for concern.\u00a0\u00a0 The body habituates to external “fixes”–it takes more of the substance to get the same effect, and sometimes new effects (unexpected, undesired) emerge.\u00a0\u00a0\u00a0 The plasticity of the brain–it’s ability to adjust to new inputs, to literally grow new connections in response to new conditions–suggests that medication effects could make long-term changes in the brain’s physical and biochemical state.<\/p>\n In addition, the cognitive enhancements in use and in development now are all aimed at things someone else wants us to do–stay awake, work harder, pay attention, sit still, remember more facts longer.\u00a0 Employers want that; teachers want that…but do we want that?<\/p>\n We don’t know that the drug keeping the young doctor “awake and alert” through a 24 hour shift of duty is maintaining the same cognitive competence as a night’s sleep.\u00a0\u00a0 We don’t know that the child given an anti-depressant because he’s depressed in a bad situation is helped as much as he would if the bad situation were fixed, instead of the child being medicated.<\/p>\n Of course there’s a place for psychoactive drugs–but calling them “cognitive enhancement” seems a stretch.\u00a0 People who do have true clinical depression can benefit from antidepressants; anti-psychotics may help those with psychosis to think more normally.\u00a0\u00a0 Anti-seizure medications do prevent seizures in some (not all) persons with seizures, and so on.\u00a0\u00a0\u00a0 New drugs appear to be able to slow down the progress of Alzheimer’s, allowing the individual to live independently longer.<\/p>\n But so often a drug is the first choice\u00a0 when someone has a problem…and this seems particularly true with children.\u00a0\u00a0 Rather than looking at the whole situation, and considering if it is a healthy one for any child (and that child in particular),\u00a0 various alphabet soup labels are tossed in the air and out comes the prescription pad.\u00a0\u00a0 Drugs are used instead of behavioral interventions, instead of a change in setting, instead of approaches that might give the brain time to make its own adjustments.<\/p>\n Then there’s the priority list.\u00a0\u00a0 Stay awake, pay attention, listen, sit still, work harder, remember these facts…and no mention of those traits and behaviors that would improve the human condition.\u00a0 No mention of enhancing a sense of justice, generosity, kindness, gentleness, the ability to forgive rather than hold grudges.<\/p>\n We don’t need more alert and canny criminals, more terrorists whose improved memories are used to hold old grudges longer, more CEOs whose single-minded attention to the short-term bottom line leads to stupid mistakes and economic trouble for the rest of us.\u00a0\u00a0 If there were real cognitive enhancing drugs, we might learn to think better–which is more than sitting still in class, learning lists of facts, and looking the teacher in the eye.<\/p>\n","protected":false},"excerpt":{"rendered":" A recent Commentary in the international science journal NATURE (11 December 2008, vol 456, p.702)\u00a0 discussed the science and ethics of the use of cognitive-enhancing drugs by the healthy.\u00a0\u00a0 As the article pointed out, substances believed to help people control attention, remain alert when working at night or extra house, and learn faster\/better are now […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[17,18],"tags":[20,49,19,21],"class_list":["post-34","post","type-post","status-publish","format-standard","hentry","category-interventions","category-opinion","tag-bioethics","tag-opinion","tag-pharmacology","tag-research"],"_links":{"self":[{"href":"http:\/\/www.speedofdark-thebook.com\/blog\/index.php?rest_route=\/wp\/v2\/posts\/34"}],"collection":[{"href":"http:\/\/www.speedofdark-thebook.com\/blog\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/www.speedofdark-thebook.com\/blog\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/www.speedofdark-thebook.com\/blog\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"http:\/\/www.speedofdark-thebook.com\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=34"}],"version-history":[{"count":1,"href":"http:\/\/www.speedofdark-thebook.com\/blog\/index.php?rest_route=\/wp\/v2\/posts\/34\/revisions"}],"predecessor-version":[{"id":35,"href":"http:\/\/www.speedofdark-thebook.com\/blog\/index.php?rest_route=\/wp\/v2\/posts\/34\/revisions\/35"}],"wp:attachment":[{"href":"http:\/\/www.speedofdark-thebook.com\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=34"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/www.speedofdark-thebook.com\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=34"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/www.speedofdark-thebook.com\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=34"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}