Benedict Carey writes, “Brain Enhancement Is Wrong, Right?” covering the emerging debate on performance-enhancing drugs in academia and other intellectual pursuits.  This debate began in the journal Nature, and exploded since then.  (I’ve covered some similar issues in a previous post, Drugs and Biosociality.) 

Carey poses us this question, “Is prescription tweaking to perform on exams, or prepare presentations and grants, really the same as injecting hormones to chase down a home run record, or win the Tour de France?” 

Whatever our answer to that question is, and it is surely to be a complex answer (more on that in a second), it is clear to me that this is already happening.  In a recent paper, I showed how heavy users already engage in “functional use”—using methamphetamine, a stimulant, to work and play more, to deal with cognitive deficits, and to change their subjective state while continuing to interact in a normal social manner.  While I am almost hesitant to say it, in this matter, drug users are already on the avant-garde. 

Given how Big Pharma (a phrase I’ve picked up from my students this semester, it’s a good one) is already pushing enhancers of all sorts (sexual enhancers, sleep enhancers, attention enhancers), we will also be dealing with increasingly available uses for pharmaceuticals. 

So, on the con side, Carey cites Francis Fukuyama, “The original purpose of medicine is to heal the sick, not turn healthy people into gods” and notes, “increased use of such drugs could raise the standard of what is considered ‘normal’ performance and widen the gap between those who have access to the medications and those who don’t — and even erode the relationship between struggle and the building of character.” 

I am reminded of Hollywood, with all its plastic surgery and “hair and make-up,” producing Greek gods for us to watch on the silver screen.  Will we have academic Greek gods, with egos to match?  (Some would argue that the egos already do…) 

But on the pro side, Carey turns to Martha Farah: “I think the analogy with sports doping is really misleading, because in sports it’s all about competition, only about who’s the best runner or home run hitter.  In academics, whether you’re a student or a researcher, there is an element of competition, but it’s secondary. The main purpose is to try to learn things, to get experience, to write papers, to do experiments. So in that case if you can do it better because you’ve got some drug on board, that would on the face of things seem like a plus.” 

The pro-con approach overlooks the problem that it’s about the drugs, it’s about the people and how they use them and how that affects other (for an illuminating discussion of a similar problem, this time on human rights, check out Greg’s post on human rights and female genital surgery at Culture Matters).  Carey’s article touches on this by recognizing the role of desire and the necessary contextual contingencies of life:

Take Dr Barbara Sahakian’s comment, “Suppose you’re preparing for the SAT, or going for a job interview — in those situations where you have to perform on that day, these drugs will be very attractive.  The desire for cognitive enhancement is very strong, maybe stronger than for beauty, or athletic ability.”

Or what Jeffrey White, a graduate student, says, “What happens if you’re in a fast-paced surgical situation and they’re not available?  Will you be able to function at the same level?”

For one person, in his or her mind, the answer is at least yes: “One person who posted anonymously on the Chronicle of Higher Education Web site said that a daily regimen of three 20-milligram doses of Adderall transformed his career: ‘I’m not talking about being able to work longer hours without sleep (although that helps),’ the posting said. ‘I’m talking about being able to take on twice the responsibility, work twice as fast, write more effectively, manage better, be more attentive, devise better and more creative strategies’.” 

Sounds rather like that French trader, supposedly chasing the high of risky trading….  Or, to put it differently, an individual-focused answer and explanation, which leaves out a lot of context and culture. 

Dr. Anjan Chatarjee calls all this “cosmetic neurology”—“We worship at the altar of progress, and to the demigod of choice.  Both are very strong undercurrents in the culture and the way this is likely to be framed is: ‘Look, we want smart people to be as productive as possible to make everybody’s lives better. We want people performing at the max, and if that means using these medicines, then great, then we should be free to choose what we want as long as we’re not harming someone.’ I’m not taking that position, but we have this winner-take-all culture and that is the way it is likely to go.”

Chatarjee ends by saying, “So the question with all of these things is, Is this enhancement, or a matter of removing the cloud over our better selves?” It is a good question, but it is not the only question.  

One thing I’ve learned about drug use and drug users is the law of unintended consequences.  Pharmaceutically-active drugs carry many of them, especially if they are used frequently over time.  Sometimes that’s the way people can function, for example, if afflicted by severe mental illness.  But sometimes the using becomes the end in itself, and the “being better” of that anonymous poster ends up as better bullshitting and empty strategies, justifications on the way to maintaining some perceived level of functioning. 

Besides unintended consequences, we also need to deal with the ethical issue of fairness—that is at the heart of this debate, having a level playing field.  That is precisely what the anonymous poster is getting around—he or she is performing better than others.  Is that cheating? 

In my mind, yes.  But that’s not really the point.  The point is that as these sorts of drugs, or rather these sorts of abilities, become increasingly available to us, what will we do about it? 

We will need to argue about what the stakes are and what the social consequences of this sort of substance use are.  The stakes are large, perhaps not as large as the millions riding on a home-run record at the individual level, but certainly larger in terms of economic, academic and research competition in an increasingly global world. 

And the social consequences?  The ones who can afford the enhancements will use them to maintain and even extend their positions of power, and those lucky enough to get into the club through whatever combination of ability and pluck will probably not speak up to rock the boat. 

This argument runs against the one blurb highlighting a box in the original Nature piece by Barbara Sahakian and Sharon Morein-Zamir, “The chief concern cautioning against the use of medications is adverse side effects.”  That sounds too much like pitchers talking about whether the risks are worth it.  Put differently, the debate is already being phrased in terms of the risks and benefits of individual drugs and the potential side-effects in individuals.  The debate builds from the same biomedical assumptions that we often argue against here—that drugs are adequately defined by their pharmacological nature and that people are inherently individual in nature. 

Similarly, the accompanying Nature survey highlights three ways to deal with potential problems: regulation by doctors, prohibition of these drugs for healthy children under 16, and testing at critical junctures (say, major qualifying exams).  These are the same sort of “top down” regulation and education efforts that have not been very successful at dealing with illegal substance abuse in the first place, so I am not sure of their effectiveness for any cognitive enhancements we decide to regulate or declare as unethical. 

Targeting the social consequences of use, ensuring a level playing field from the get-go (say, equal access to good education), encouraging the motives and ideas people already have about what counts as proper and improper sorts of enhancements—these can also be effective strategies.  This sort of approach goes hand-in-hand with overcoming old assumptions in our research and our culture—mind vs. body, the individual vs. society—so I am not certain it will happen anytime soon.  But one can always hope… 

As I’ve learned over the years, almost everything people search for from drug use can be found in everyday life.  Sometimes it might seem harder to get, sometimes it might take more effort or sacrifice, but it is, for most people most of the time, available in their lives. 

The original Nature piece acknowledges this: “Ultimately, our drug use is a reflection of our society and should never be considered without the broader context of why healthy people choose to use the drugs in the first place. There are other options available for coping with everyday stresses, such as improving the work–life balance or relaxation. Sleep, psychological and behavioural problems can be addressed through alternative methods including psychological treatments, and enhanced cognition can be obtained through education and other means.” 

The only thing I might change are the assumptions packed into the paragraph—treating the “broader context” as if it is something separate, placing the emphasis on “choice” alone, the focus on techniques and methods.  While these are important issues, they fail in the end to adequately characterize why people might use or not use certain drugs and what and how we might do something about that.