Stanford University Medical Center, April 2004
Ethics of boosting brainpower debated by researchers
STANFORD, Calif. - For decades people have nipped a wrinkle here, reduced
a nose size there or paid for help boosting test scores. With this history
of paying to improve our bodies and minds, why not extend that liberty
to memory-improving drugs or brain-enhancing implants?
These and other questions being raised by modern neuroscience were the
topic of a meeting of neuroscientists, ethicists and psychologists funded
by the National Science Foundation and the New York Academy of Sciences.
The group, led by Judy Illes, senior research scholar in biomedical ethics
and in radiology at the Stanford University School of Medicine, will publish
their thoughts in the April 20 online issue of Nature Reviews Neuroscience.
The article will also appear in the May print issue of the journal. The
group's goals were to outline both the ethical issues raised by modern
neuroscience and the steps scientists should take, if any.
Plastic surgery and neural enhancement both raise safety issues, Illes
said. However, she and co-chair Martha Farah, PhD, professor of psychology
at the University of Pennsylvania, feel the risks are more acceptable
when treating an illness rather than taking normal, healthy people and
trying to make them better.
Illes said the key difference between physical enhancements such as plastic
surgery and neural enhancement through drugs or brain implants comes down
to personhood. A nose job doesn't change who you are. Drugs might, she
said. "Am I the same person on Ritalin as off?" Farah asked.
Farah said there have been no studies that establish the long-term effects
of brain function in children who take Ritalin to control hyperactivity
or in people who take medication for depression. It could be that drugs
alter the way the brain works, fundamentally changing personality. The
drugs may even have unanticipated consequences such as speeding the brain's
decline with old age.
The question becomes more complicated for drugs such as modafinil, which
can improve memory or the ability to concentrate. These have obvious appeal
for professionals wanting an edge, but at what cost? "I think it
is important for science to move forward," Illes said. "I worry
about how the science will be conveyed to the public. Will it play on
fears of not having a competitive edge?"
If the answer is yes, Illes brings up a few hypothetical situations.
What if some people in a given field take a drug to make themselves doubly
productive? Will their productivity put pressure on colleagues to use
the drugs, much like some professional athletes feel competitive pressure
to take steroids? Would differences in productivity cause conflicts between
colleagues or inequalities in pay?
These scenarios raise issues about what scientists should do to prevent
the abuse of brain enhancement research. In their review, Illes and her
colleagues quote Francis Fukuyama, the Omer L. and Nancy Hirst Professor
of Public Policy at the Institute of Public Policy at George Mason University,
who has called for legislation to control the use of drugs or devices
that alter the way the brain functions.
Legislation isn't necessary, according to the group, but caution is.
Illes and Farah argue that by being proactive in thinking about ethical
issues, ethicists, neurologists and physicians can develop guidelines
to aid decisions about how research findings are used and communicated
to the public.
Robert Cook-Deegan, MD, director of Duke Institute for Genome Sciences
and Policy's Center for Genome Ethics, Law and Policy, hopes that such
guidelines will distinguish between potentially harmful brain alterations
and the type of brain-altering activities that have taken place since
the dawn of civilization. Every time a person smokes a cigarette, drinks
a glass of wine or wakes up with a cup of coffee, the workings of that
person's brain are being changed, he said, so how is taking a drug any
different?
"Caffeine then modafinil; what is next?" said Cook-Deegan,
a co-author of the paper.
Cook-Deegan said drug treatments follow a well-trammeled path from development
for treating a disease such as depression, Alzheimer's or narcolepsy,
to use for less established medical conditions. The drug Ritalin, used
to treat children with attention deficit hyperactivity disorder, is a
classic example. Where it was once a welcome relief to those rare parents
with hard-to-manage kids, the drug is now widely prescribed and is even
taken by college students needing help focusing before exams.
In addition to drugs, Illes said that modern brain imaging techniques
may reveal aspects of personality such as a tendency to lie or be aggressive.
As the technology improves doctors must decide who should have access
to this information and whether they should treat a neural tendency rather
than an actual behavior.
Illes said the panel's discussion was limited to examples of what neuroscientists
may be able to detect or treat in the future. Through such meetings, she
hopes the medical community will be poised to act responsibly when those
future technologies become a reality.
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