Advocacy of cognition enhancing drugs.

Stimulants such as methyl-phenidate (Ritalin) and modafinil (Provigil), familiar as treatments for attention deficit hyperactivity disorder and narcolepsy respectively, are increasingly used as 'smart drugs' by students and more widely as a boost to intellectual creativity. Should society recognize the demand for cognitive enhancement? The trend has been resisted by some on the grounds of safety, 'medicalization' and social inequality. Urging responsible use of cognitive-enhancing drugs by the healthy, Greely et al., in an open access article, think that society must respond to the growing demand for cognitive enhancement. A few clips from their article:

Ritalin (methyphenidate) and Adderall (mixed amphetamine salts), and are prescribed mainly for the treatment of attention deficit hyperactivity disorder (ADHD). Because of their effects on the catecholamine system, these drugs increase executive functions in patients and most healthy normal people, improving their abilities to focus their attention, manipulate information in working memory and flexibly control their responses...A newer drug, modafinil (Provigil), has also shown enhancement potential. Modafinil is approved for the treatment of fatigue caused by narcolepsy, sleep apnoea and shift-work sleep disorder....laboratory studies have shown that modafinil enhances aspects of executive function in rested healthy adults, particularly inhibitory control.

Many people have doubts about the moral status of enhancement drugs for reasons ranging from the pragmatic to the philosophical, including concerns about short-circuiting personal agency and undermining the value of human effort. Kass, for example, has written of the subtle but, in his view, important differences between human enhancement through biotechnology and through more traditional means. Such arguments have been persuasively rejected. Three arguments against the use of cognitive enhancement by the healthy quickly bubble to the surface in most discussions: that it is cheating, that it is unnatural and that it amounts to drug abuse.

In the context of sports, pharmacological performance enhancement is indeed cheating. But, of course, it is cheating because it is against the rules. Any good set of rules would need to distinguish today's allowed cognitive enhancements, from private tutors to double espressos, from the newer methods, if they are to be banned.

As for an appeal to the 'natural', the lives of almost all living humans are deeply unnatural; our homes, our clothes and our food — to say nothing of the medical care we enjoy — bear little relation to our species' 'natural' state. Given the many cognitive-enhancing tools we accept already, from writing to laptop computers, why draw the line here and say, thus far but no further?

Like all new technologies, cognitive enhancement can be used well or poorly. We should welcome new methods of improving our brain function. In a world in which human workspans and lifespans are increasing, cognitive enhancement tools — including the pharmacological — will be increasingly useful for improved quality of life and extended work productivity, as well as to stave off normal and pathological age-related cognitive declines. Safe and effective cognitive enhancers will benefit both the individual and society.

But it would also be foolish to ignore problems that such use of drugs could create or exacerbate. With this, as with other technologies, we need to think and work hard to maximize its benefits and minimize its harms.