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Pop a smart pill? Why not, says a group of neuroethicists

December 11, 2008 | 12:46 pm

Across the country, it's crunchtime: time for finals, end-of-year reports; time to whomp up some brilliant proposal to save your job. Around now, you might be thinking if a pill could make you smarter, more creative, able to work effectively for longer, you'd take it.

Yes, you would, and you've got a fair amount of company. A 2005 survey published in the journal Addiction found that some 7% of college students -- as high as 25% at some universities -- say they have taken drugs illicitly to improve their academic performance.

And you wouldn't be asking yourself, "Geez, is this fair?" Or, "Is the risk of side effects -- including racing heart, stomach upset, addiction -- worth it?" Or, "Isn't this against the law?"

Well, in this week's issue of Nature (published online Dec. 7), an eminent group of ethicists and neuroscientists ask -- and answer -- the questions you're too stressed out by end-of-year demands to ask. And they offer a controversial conclusion on whether this is an experiment that we as a society want to run.(Spoiler alert: "We should welcome new methods to enhance our brain function ... Safe and effective cognitive enhancers will benefit both the individual and society.")

In answer to the questions you might not have thought to ask:

-- Yes, in most cases, cognitive enhancement with prescription pharmaceuticals is against the law -- and when they did that with alcohol, it was called Prohibition, and it didn't work out very well.

-- And no, it's not entirely fair -- although it's perfectly fair, if you can afford it, to bone up for a test with a tutor, exercise and eat nutritious food, or drink four double-lattes before sitting down to write a proposal, all of which have been shown to improve your brain power. ("In short," they write, "cognitive enhancing drugs seem morally equivalent to other, more familiar enhancements.")

-- As for weighing the benefits against the risks, isn't that for YOU to decide? (Wait a minute, though, do you KNOW all the risks?)

OK, so it's not, as a former Bush official put it in another context, a slam-dunk; we don't exactly know how drugs with proven (or as yet unproven) powers of cognitive enhancement will affect people who are perfectly well but wish they were smarter. Pills that improve consolidation of memories, for instance, might make it impossible to put from your mind that hideous car crash you drove by this morning and get to work; they might make you remember so much that the important stuff doesn't stand out anymore; you may find yourself unable to face a deadline without them anymore, or they may have unforeseen effects on your metabolism, or your heart.

But given the possible benefits of new discoveries, greater productivity and fewer lives and hours lost to error (or sleep), those are concerns that could be quantified by clinical trials and studies and research, says the group that penned the commentary. And in spite of concerns over how fair it is to get smart without working at it, or whether well people should take drugs to make themselves better, that research should be allowed to proceed, they write. Because, frankly, people are already taking these drugs in a bid to get smart -- drugs with commercial names like Ritalin (approved for treatment of attention-deficit hyperactivity disorder symptoms), ProVigil (approved for narcolepsy and excessive daytime sleepiness), Aricept (approved for Alzheimer's disease). At the same time, they write, physicians -- to whom patients often look for advice and a prescription when considering a "lifestyle" drug -- should be discussing this openly and devising some consensus on where to draw the line, the group says.

The seven authors include Ronald C. Kessler of Harvard Medical School, Stanford Law School's Henry Greely, and neuroscientists Michael Gazzaniga of UC Santa Barbara, Barbara Sahakian of Cambridge University (who has conducted several studies on cognitive enhancement in normal subjects) and  Martha J. Farah of the University of Pennsylvania. At the start of a new U.S. presidential administration, their recommendations offer a marked contrast to the go-slow tenor struck by  President George W. Bush's Council on Bioethics when they considered cognitive enhancement back in 2003.

But before you reach for your kid's Ritalin, or your mother's Aricept, the Nature writers warn that there are clearly lines to be drawn. They suggest that kids whose grades, motivation or brain power don't quite meet the standards of their overachieving parents (or teachers or school administrators) should certainly not be drugged without their consent -- and by the way, they're too young and easily led to give their consent. Employers should not coerce their employees to take drugs to increase their output of, say, computer code or newspaper copy. But if the employees were engaged in work on which peoples' lives and safety depend -- think emergency room docs or pilots -- perhaps their professional societies or unions should hammer out some exceptions.

In short, they say, let's talk about it. What's your view?

-- Melissa Healy