Tuesday, April 21, 2015

A Special Event Reprise: Exploring the Ethics of Cognitive Enhancement and the University's Policy at Emory

Last month, Emory’s Committee on Academic Integrity and the Barkley Forum collaborated to host “Study Drugs: Exploring the Ethics of Cognitive Enhancement and the University’s Policy.” The program featured a debate among four Emory University undergraduates and a discussion between Emory Center for Ethics's very own Dr. Karen Rommelfanger and Dr. John Banja in addition to Willie Bannister, Emory’s Associate Director of Health Promotion. This event, organized by Emory University senior Grant Schleifer, brought out students from many areas of study to weigh in on how the university can better address the potential issue of increasing usage of cognitive enhancement drugs within Emory’s student body.

In an effort to relay the contents of the event to the greater student body, the speeches from the event are displayed below in the order of their presentation. This 20-minute debate included two affirmative speeches advocating that Emory ought to take a stance on the use of cognitive enhancement drugs and set up a regulatory regime to oversee students’ use of cognitive enhancers.  The negative team argued against this approach to the “study drugs” problem by presenting potential negative consequences to greater monitoring of the intake of cognitive enhancers, such as creating a larger black market for drugs like Adderall.

Further, Dr. Jason Ciejka, Emory’s Associate Director of the Honor Council attended this event and provided us with a wonderful commentary on the proceedings. Given his role at the university, his perspective on issues such as cognitive enhancement is incredibly valuable and aids in further understanding the intersection of ethics and policy at the university level. His commentary along with the content of all the speeches from the event will demonstrate how academics, administrators, and students can collaborate to discuss thorny ethical issues that impact all Emory community members and will hopefully stimulate further discussion on this blog.



The First Affirmative Speech
By: Javi Reyes

In an effort to keep up with the rigorous collegiate academic climate, students have chosen to pick up a peculiar study habit. Drugs like Adderall are being popped like Advil to obtain an academic advantage. These forms of medication are usually used to treat individuals who suffer from Attention Deficit Hyperactivity Disorder (ADHD) and Attention Deficit Disorder (ADD). George Krucik says that these sorts of drugs are designed to improve hyperactivity, impulsive behavior, and attention span. According to the Cleveland Clinic, stimulants improve symptoms of ADHD in 70 to 80 percent of children and 70 percent of adults. Despite the short-term positive affect, abusing these drugs is cheating and dangerous.

According to a study released by the University of Texas, these cognitive stimulants have the potential to result in an over-dependence on the drug, which will lead to higher doses and eventually inability to concentrate without it. Without these study drugs, students from across the country have contributed personal testimonies that have a recurring theme: abusers of this drug lack all motivation when off of a drug and experience varying degrees of withdrawal immediately after increased usage and dosage.  Along with the increased concentration, there is a tradeoff with sleep and an increase in heart rate. According to Edward Bell, professor of clinical sciences at Drake University College of Pharmacy, “most people that take the drug at a normal dose to study for the night may not experience any sudden side effects, but it may aggravate a potential heart problem.” Furthermore, the exploitation of the body’s dopamine levels reduces energy substantially, leading to exhaustion and potentially resulting in long-term side effects like anxiety and depression.

The worst effects of study drugs come to the surface when it is mixed with other drugs and alcohol. Dr. Emily Kensington says that study drugs “cover up” the effects of alcohol, which means students may not recognize how intoxicated they may be, which raises the risk of alcohol poisoning. A study released by the National Survey on Drug Use and Health reported that up to 90 percent of full-time students using Adderall recreationally participated in binge drinking episodes in the last year.

Despite arguments for the decreased usage of drugs like Adderall and Ritalin, according to Martha Farah, director at the Center for Cognitive Neuroscience at the University of Pennsylvania, 1 in 4 college students on some campuses have abused study drugs. And as reported by TIME magazine, Ivy League institutions and other highly ranked universities exhibit about 20% usage.

Beyond the health factors, cognitive stimulants could be considered cheating. It is illegal for students who are not prescribed the drug to use or possess these types of enhancements. Similar to using steroids for athletic competitions, it gives students who abuse the drug an academic edge over those who do not use or cannot obtain Adderall.

In order to address the problem, Emory University should implement a regulatory regime and generate an education process similar to AlcoholEdu and Haven to highlight the health risks to abusing drugs such as Adderall and Vyvanse.

Despite the fact that the solution may not be able to prevent the students who want the drug to obtain it, it is important for Emory to take a position on the matter and ensure the healthiness of its student body. This proposal may add on to existing preventative measures that curb the use of study drugs.

When the health of a university’s students and academic integrity are at stake, the effort to mitigate the negative effects outweighs the alternative to allow for the unregulated and uneducated use of highly addictive drugs on Emory’s campus.

The First Negative Speech
By: Mili Raina

While we can agree that usage of study drugs such as Vivance, Adderall, and Ritalin may be on the rise, a regulatory regime is not the way to go about fixing this problem.

Firstly, how would this regulatory regime work? There are massive problems with establishing a regime that keeps track of students’ medications and forces them to attend mandatory counseling to investigate whether or not they are abusing that drug – it antagonizes students who have ADHD and creates a culture of distrust of Emory healthcare professionals. Students suffering from depression, stress, tests, and other problems would think twice before consulting Emory counseling and psychological services as they could be fearful that anything they say would be reported to the Honor council or other disciplinary committee. Instead of going to speak to a counselor about their addiction to Vivance, they would keep using it because a conversation with a counselor would put them in danger of getting an honor code violation. This would escalate, as students with other abuse problems or even depression and anxiety disorders would become suspicious of the services they were assured were “confidential” and stop seeking help.

According to a study by the Anxiety and Depression Association of America, anxiety disorders are one of the most common mental health problems on college campuses. Forty million U.S. adults suffer from an anxiety disorder, and 75 percent of them experience their first episode of anxiety between age 17 and 22. 80 percent say they frequently or sometimes experience daily stress. As a student of Emory college and having seen the cutthroat competition of the business school, I understand the pressure and stress students feel to turn to study drugs to give them the edge on tests and papers. Maybe we should instead question the learning environment before accusing study drug users of cheating and judgmentally imposing our morals on them.

After all the progress these departments have made in the past couple years, a haphazard attempt to control study drugs would put Emory’s students at more risk than if there was no regulatory regime.

Secondly, the regulatory regime would only create a larger black market of illegal drugs.  Just like students who use marijuana, the students who obtain study drugs from prescription owners on campus would shift to other dealers. This means that the regulatory regime wouldn’t catch any students who buy these study drugs illegally but put unneeded pressure on students who actually have ADHD.

For this reason the regulatory regime would make no true progress in enforcing the honor code.

The Second Affirmative Speech
By: Mollie Fiero 

Emory University ought to implement a regulatory regime in order to combat the physical harms of study drugs as well as to take a public stance against them. They should be backed by punitive force as well as the ability to mandate counseling and health follow-up services.

I’d like to begin by introducing an additional point of consideration – the inherent unequal access to these drugs. Emory offers many different kinds of study aids or techniques for students to get a leg up; university services like EPass, OUE, CAPS, and individual professors are able to give opportunities to all students to further their academic careers. We would take no objection to students trying to master their subjects or expand their knowledge. However, study drugs are a privilege reserved only for the economic elite. Emory prides itself on racial and socioeconomic diversity, among other things, and study drugs, acquired either on the “black market” or through a corrupted physician, require hefty sums of money that only the wealthy can take advantage of. A study at the University of Texas labeled the dangers of study drugs as ones that primarily concern wealthy, white students. Although the dangers may be exacerbated for this group, that means the access is primarily limited to this group as well. We cannot turn a blind eye to the economic inequality and performance “benefits” exacerbated by these drugs.

Although it may be true that ADHD is an instance of a false or unnecessary pathologization of a variety of so-called symptoms, this is irrelevant to the central question of this debate. These drugs exist, they are used, and abused. Even if we ought to change our approach to disease and treatment, this may be an apt critique of the Western medical model but the proposed alternative is long-term at best. In the short term, we have an obligation to recognize the dangers to our student population.

Our opponents have said that a regulatory regime may not be an effective response to the study drugs problem. There are two primary responses to this argument. The first is the value of norms on our campus. Not only would an informative program similar to AlcoholEdu provide a base level of knowledge about the dangers of these drugs, it would catalyze on-campus discussions and dialogue regarding their use. Were the university to formally prohibit their use, it could further a system of beliefs that sides with academic honesty and hard work over the abuse of study drugs. The second argument is the importance of education. Simply by requiring and implementing this regulatory regime we would mitigate the risk of an on-campus death or the serious bodily harm that can follow from their abuse.

It has been suggested that a regulatory regime would only fuel the black market or result in students with valid prescriptions being antagonized. I believe that our proposed changes would both prevent the spread of these drugs in the first place through education, as well as allow a more effective shutdown of any illegal market through a more transparent and clear regulatory mechanism.

Arguments have been made that the unauthorized use of these drugs is not a form of academic dishonesty or cheating.

As with any legal evaluation, intent of an action informs its criminality. The fact of the matter is, students are abusing these drugs because they feel it gives them an edge. Were a student to be caught trying to copy off another’s exam, even if they accidentally misread their neighbor’s answers, they would still be in violation of the honor code. There is a population of our student body that considers these drugs to be their illegal lifeline, their silver bullet in the form of a small orange or blue pill, that risks not only their bodily and mental health but also violates the law. Consider the reason we all find ourselves here pursuing a prestigious liberal arts degree. We’ve chosen rigor, challenge, and accepted the burden and hard work that our professors, colleagues, and administrators expect of us.

These prescription medications were invented to be equalizers to level the playing field for those with conditions like ADD and ADHD, for whom classroom environments present distinct challenges. The drugs were both created and are only legally provided for those who have a distinct requirement for them.

In fact, students that are prescribed these medications for their own needs face a risk of their medications being stolen or being pressured to give away or sell it to others who want to make use of them without following the legal and medical procedures required.

The university has an obligation to look after the welfare of students both academically and physically. The physiological effects of abusing the drugs have been undisputed in this debate between concerns over potentially fatal alcohol poisoning, and a restructuring of the brain chemistry that fundamentally changes the way that we are able to think. College lasts four years, and many take it as a sprint. But life is a marathon, and preparedness requires the ability to overcome challenges.

Emory University prides itself as a space where academically engaged, ethically concerned students can become global thinkers, collaborative individuals, and productive and fair members of society. Through this commitment to the liberal arts and accountability, it draws a diverse and engaged base of students, who are each given resources to complete an outstanding four-year experience. We believe the role of the university is to maintain this space, while ensuring the safety and integrity of its students, which can require intervention when students are known to be partaking in dangerous activities. We believe that through a changed policy the public stance of the university can both shift norms and educate regarding the dangers of study drugs.

Ramifications to community, mind, and body alike demand a reexamination of the study drug problem and the implementation of a regulatory regime to officially sanction and mitigate the abuse of these drugs on our campus. Thank you.

The Second Negative Speech
By: Mike Demers 

My first observation: the supposed obviousness of ADHD is not so obvious. Indeed, Dr. Bruce Perry said ADHD should not be considered  “a real disease.” In fact, “It is best thought of as a description. If you look at how you end up with that label, it is remarkable because any one of us at any given time would fit at least a couple of those criteria.”

The preceding speeches have uncritically accepted and moved from an assumption based on abstraction and pathologization of behavior deemed evidence of the “psychological phenomenon” of ADHD. Focus is only arbitrarily measurable and is influenced by complex factors that unsettle the supposedly objective nature of this phenomenon.

There is no evidence to suggest that AlcoholEDU lowers alcohol consumption on campus; throwing facts and expert knowledge at an individual who desires a substance does little to change it.

Moreover, what of nicotine and coffee, both of which heighten cognitive function? Are those not also cheating under this interpretation?

My second observation: naming of cheating, or moral deviance, and destructive health practices bound up in alternative ways of consuming and being in the world more generally, are not neutral. I insist they must be understood in the context of broader systems of injustice such as exploitative economic power relations immanent to capitalism. The privileging of this academic “edge” or pharmaceutical force as a primary instance of cheating relies on an assumption that we can return to an equal plane that would exist without these drugs. This is an erasure of the complexity and multiplicity of injustices I only began to explicate above.

Even more compellingly, these drugs are generative of a heightened spirit. Paul Erdö was a Jewish-Hungarian mathematician and an avid user of amphetamines before these substances were ever regulated. After abstaining from use for a month, he remarked that mathematics had been set back by a month.

ADHD, indeed, might very well be nothing more than a construct applied to particular modes of subjectivity which fail to meet the demands of production.

The regulation of study drugs is an illiberal war fought for liberal values. The prolific German philosopher Friedrich Nietzsche remarked: “Liberal institutions cease to be liberal as soon as they are attained: later on, there are no worse and no more thorough injurers of freedom than liberal institutions. Their effects are known well enough: they undermine the will to power; they level mountain and valley, and call that morality; they make men small, cowardly, and hedonistic—every time it is the herd animal that triumphs with them…The war for liberal institutions, which, as a war, permits illiberal instincts to continue.”



Dr. Jason Ciejka’s Commentary

As long as there have been tests, there has been cheating. Some of the methods have not changed much at all: sneaking a peek at a neighbor’s exam or hiding a crib note. But other ways have only emerged as new technologies have developed. Plagiarism (and its detection) became easier with the rise of the internet; online translators created problems for foreign language classes; and the prevalence of smart phones provided a new and constant temptation during exams. One of the more recent developments has been the use (or perhaps abuse) of study drugs by students without prescriptions. This practice represents a particularly thorny problem in the field of academic integrity not only because of the difficulty of enforcing any potential regulations but also because of serious disagreements about whether it even constitutes academic dishonesty.

The forum on study drugs was generated entirely through the interest of students on Emory’s Committee on Academic Integrity who sensed that the use of study drugs was a problem for some of their peers. The members also recognized that there had been little sustained discussion on campus about the nature of this practice or solutions for addressing the issue. The forum proved to be a frank and open discussion about different facets of this subject, touching upon the state of research, the ethics of study drugs, questions about their efficacy and risks, and the potential role of the university in curbing the practice. As topics in academic integrity so often do, the forum also opened up a broader conversation about the purpose of a university education.

As someone responsible for educating students about academic honesty, I was left with more questions than answers (a sure sign of the forum’s success). There are serious gaps in the research about study drugs, and without more data, policies to address the issue could be impractical or counterproductive. However, the forum’s debates and presentations helped get at the heart of why many students consider the use of non-prescribed study drugs dishonest. If study drugs are in fact effective, then they could create an unfair playing field. A student who can afford the pills, has access to them, and is willing to look past the legal implications could gain an advantage on a test or assignment. From this perspective, the act might not seem all that different from a student who accesses an unauthorized test bank or takes six hours—instead of the required three—to complete a take home exam. The issue might look very different in a few decades as medicine advances and the body of research grows. But for now, I think the key lies in educating students about the potential legal and physical risks involved in taking non-prescribed medications and reminding them of the joy of learning for its own sake.
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"The discussion and turnout at the event demonstrated broad interest both in the topic of study drugs and in the nature of the Honor Code at Emory. Our speakers from the Emory Center for Ethics offered a perspective that balanced well with our speaker from the Office of Health Promotion...This event went almost exactly as I had imagined during our brainstorming in November 2013, which makes me enthusiastic about the potential for student leaders to develop campus-wide programs dealing in topics that ethically engage students from diverse areas of the university."    
                                                  -- Grant Schleifer, the event coordinator


Want to cite this post?

Emory Neuroethics Program. (2015). A Special Event Reprise: Exploring the Ethics of Cognitive Enhancement and the University's Policy at Emory. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2015/04/a-special-event-reprise-exploring.html

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