A report by the Academy of Medical Sciences looking at different aspects of drug use and mental health has identified a growing trend for off-label use of drugs intended for the treatment of diseases including narcolepsy, ADHD and Alzheimer’s. The use of such drugs by a healthy individual can improve memory, alertness and concentration. While the report does not condemn the practice, it raises a number of potential concerns over safety, and fairness. Professor Les Iversen, report co-author, highlighted concerns that the use of enhancement in exams would unfairly advantage wealthier students, and suggested that the use of such drugs could be considered cheating. The report recommends that legislation is prepared to tackle the misuse of such drugs, including the potential for urine testing in schools and universities.
Below are responses from Julian Savulescu, Nick Bostrom, Anders Sandberg and Mark Sheehan on the effects of cognitive enhancing drugs, and the issue of cheating
The Use of Cognitive Enhancing Drugs
Julian Savulescu’s response:
Brain boosting drugs have been used for many years by students in the form of caffeine, often in very high doses, and nicotine. In fact the world’s second largest export is coffee, which means that the second largest export is in fact for cognitive enhancement. The market for decaffeinated coffee is infinitesimally smaller. We already have an established industry around cognitive enhancement. The right response to the use of the new generation of brain boosting drugs, like Modafinil, is to adopt a rational strategy, as we should do with the use of doping in sport (quote articles) and not necessarily to ban them. The right response, at this stage, is to do proper research on their effects, beneficial and adverse, on a healthy population. Sadly, despite the fact that the off label market for Modafinil is over 1 billion dollars, no such research is occurring. Policy in the absence of evidence and facts is likely to be bad policy. For all we know, these may be better than the use of nicotine or caffeine, and safer.
Human Enhancement papers, podcasts and other resources for download
Nick Bostrom’s Response
The report is correct in emphasizing the need for better understanding of the effects of using potential cognitive enhancers. We especially need better data on long- term in an ecological setting. It is one thing to show a short-term positive effect on some artificial lab task; it is quite another to show that long-term use actually leads to sustainable performance gains on important real-world tasks, such as academic output. The former is easier to demonstrate, but the latter is what ultimately matters.
The report fails, however, to recognize the urgent need for research to develop better cognitive enhancers.
Progress on developing effective cognitive enhancers, and on understanding their long-term effects, is hampered by a shortage of focused research in this area. In general, the potential of enhancement medicine has yet to be fully appreciated.
Prevailing patterns of medical funding and regulation are organized around the concept of disease. Every pharmaceutical on the market with alleged cognitive- enhancing effects was developed as a treatment for some pathology. Its good effects on healthy adults’ brains were discovered as fortuitous side effects. This disease-centred framework impedes the development of safe and effective enhancing medicines and has several consequences.
First, it makes funding hard to come by; it also makes it difficult to obtain regulatory approval for enhancement drugs. The result is that those who wish to research cognitive enhancement must often mask their work under the guise of addressing some ‘respectable’ disease.
Second, in order to gain access to the benefits of a cognitive enhancer, the user must first be classified as sick. This leads to the expansion of diagnostic categories and the invention of new pathological conditions – sometimes to cover
cases that in earlier times would have been regarded as within normal human variation.
Third, it contributes to inequity in access. The main obstacle for someone who might be interested in trying modafinil or a related drug is not cost (which is similar to that of a large cup of coffee) but information: knowing that the drug exists and how to obtain it. This discriminates against people with little access to information.
With the cockcrow of enhancement medicine, we need to retool our regulatory paradigm. It is not only special occupations such as military commandosand air-traffic controllers that would benefit from good enhancement drugs. Other jobs are just as important and intellectually taxing – including the jobs of many scientists and academics. Anything that can help our brains deal better with the complex challenges of the twenty-first century is to be not only welcomed but actively sought. But it will require substantial investment to develop interventions that are both safe and effective in long-term use.
Is the use of Cognitive Enhancing Drugs Cheating?
Mark Sheehan’s Response
In order to claim that the use of cognitive enhancing drugs is cheating and unjust we need a morally relevant distinction between taking drugs and other kinds of advantage conferring strategies.
If we compare a student who takes drugs to improve his cognitive ability with another who studies consistently we can see a difference. We might think that studying consistently is part of the whole process of education — teaching discipline, persistence and diligence as well conveying information and understanding of particular subjects. The process of education on this view is a complex activity that comes with its own set of goals and rules governing their achievement. In this light taking ‘brain-boosting’ drugs seems to violate part of the point of the education process.
However things are not nearly so straightforward when we consider the kinds of practices that we take to be an acceptable part of our society’s actual education process and, in particular, the role that education plays in the competitive social context. Here being better educated brings other non-education related goods.
The unfair advantage that is said to be gained by taking drugs is similarly gained through extra tutoring, extra resources and better facilities. People pay vast sums for private schooling — to give their child the edge — and yet this is rarely, if ever, labelled cheating. The advantage that private schooling brings is largely relative in much the same way as taking ‘brain-boosting’ drugs. If everyone had access to the resources of the best private schools, children would, in certain ways, be better educated, but is unlikely that large fees would be paid for something that everyone had. Similarly, if everyone had access to brain-boosting drugs, the advantage would be significantly reduced.
Anders Sandberg’s Response:
Whether the use of cognitive enhancers in education is good or bad very much depends on the goals of education and whether the drug helps achieve them. If the goal of education is a competition for high grades, then the drugs would be akin to doping and only add an unfair positional advantage to users (and if everybody used them, nobody would gain anything). If the goal of education is to give students information and the drugs allow them to learn it better, then safe drugs should be encouraged. If the goal of education is (among other things) to prepare students for real life and to become autonomous individuals, then on one hand they need to learn to solve problems under less than ideal circumstances, but also how to use available tools – be they calculators or attention enhancers. Especially in higher academia the emphasis is more on what people achieve and not how; that many of the theorems of the mathematician Paul Erdös were proven under the influence of amphetamines does not diminish their intellectual brilliance or importance.
However, most cognition enhancing drugs have relatively narrow effects that are suitable for particular kinds of mental tasks: learning how to use them optimally (including when not to use them) would be a key issue. This cannot be done without open and frank discussion of the risks and benefits, something attempts at suppressing the use is unlikely to achieve. It is likely that some of the drugs used today only give placebo benefits in education; research that actually examine this and point out what doesn’t work may be much more discouraging than any drug testing. The problem with health risks can be handled in many ways.
In general harm reduction, in the form of allowing drug use to be medically monitored, seems much more likely to work than preventing use.
Researching how the drugs actually work in a real setting is also likely to help reduce health risks.
Currently access to enhancement drugs requires social capital rather than economic wealth: having a compliant GP prescribe the drug, ordering it via the internet or getting it from friends has a relatively small monetary cost but requires connections, making it access unequal.
Over-the-counter enhancing drugs could (especially if widely used) be cheap enough that most who wished to use them could do so. If enhancement were having sufficiently beneficial effects there is no reason why not government subsidies could not equalize access.
It is important to keep the abilities of these drugs in perspective:
they in general give 10-20% increase in performance on particular psychological tests, which suggest that they could be helpful but not earth-shattering in education. Access (and skill in accessing) online information sources, software tools and mental training can likely achieve far larger effects. Recent developments of computer training of working memory and fluid intelligence suggest that cognition enhancement can be done without chemicals: the ethical and social challenges remain largely the same, but the enhancement would be outside of any drug policy.
This post is also available on the James Martin 21st Century School Blog